Goodbye Mango

I’ve worked my last shift. I’ve packed up my things and left my white nursing scrub tops and stethoscope behind in Mango. I hugged my friends goodbye, hopped in a vehicle early in the morning and arrived in the capital, 295 miles away from a place that became home.

Right now I’m traveling for a short time with my sister before heading back to Australia. So far we have visited two of her Compassion sponsor children (one in Togo and one in Ghana) and have been very impressed by Compassion’s work in the lives of the two children and the children in each project.

In between visiting kids and being a tourist, I have been trying to process and debrief what happened in my life over the last two months.
I don’t really know where to begin. Before working in Mango at the Hospital of Hope I had never worked in a place where I felt so consistently stretched and stressed that my patients were going to die. Sometimes in other places I’ve worked, after a busy shift we joke that everyone is alive so that’s our nursing job done, but in Mango so often you can’t even say that. Instead we joke that if everyone survived our shift it was a good day. Of course there are good and bad moments of every shift but with so little staff, such high patient to nurse numbers and high acuity (very sick patients), it really takes nursing to a new level of stress.

One shift I had an admission of a boy who was writhing around on his bed, gasping for air, dripping saliva. It was during the afternoon when we take our mandatory (by Togolese government) 2 hour lunch break (the only break we get from 0700-1930). During this time we take over one other nurse's patient load which end up being half the hospital (your patients plus theirs). So, not only did I have a boy who was the definition of a hot mess (an American term which I have wholeheartedly embraced), but I had a bunch of other sick and unconscious kids too.

Before I let the other nurse go on break, I went to assess this kid and give him some medications. He was doing circles in his bed. The leads from the cardiac monitor was pulled off and stuck to his stomach, his IV line was pulled tight across the bed, the non-rebreather oxygen mask was around his neck and not on his face. What a mess! It wasn't simply a matter of reorganizing the wires and tubes, because this kid just simply couldn't stay still, but to make matter worse, it sounded as though he was choking to death. I went out to find a doctor but couldn't find her. I found the other nurse and she said that he sounded like that previously but she would help me try to settle him. I walked around trying to find the doctor while inside I was panicking thinking that any moment he would have a respiratory arrest and I would have to do CPR and we would lose another child. My stress response is crying, which is super unhelpful. So I choked back tears, clenched my teeth and did what I could.

Eventually I got him calmed down and when I saw him touch his mama tenderly on the face, I repented of my frustration towards him, realising that it wasn't him, but his sickness that was making him so hard to care for.

When I handed over to the nurse that evening, I was fairly certain that he wouldn't last her shift. After she assessed him, she didn't think he would either.

What I have come to realise is that I just don't know what God is doing and why some children survive and others don't, but this child managed to pull through. Several days later when he was much more healthy, I asked his papa if I could take a photo so that I could remember that despite the situation looking hopeless, he is alive and well.

 

On my last day of work I had a premie baby have 3 apneas and a young boy (cared for by another nurse but in the same room as my patients) drop his pulse too low several times, requiring a long sternal rub (it causes a pain response) to increase his heart rate and a baby have no urine output and an increasing heart rate all before 11:00. Thankfully we had an extra nurse that day because the previous day I had all the kids (the regular paeds ward and paeds ICU) and I couldn’t keep up and then throw in a baby who is very sick and I wondered how on earth I would keep them all alive. The crazy thing is, we have nurse aids that do all the vital signs. Nurse friends- you know how much time recording and paper charting vitals take, remove that from the equation and I’m giving meds, fluids, feeds, doing assessments and trying to keep up with charting everything (which is way less than a western hospital). Often at work in Australia I feel like all I ever do it vitals, hand out food, showers, make beds, fill out paperwork and a few meds. You could not find two nursing jobs more different.

Aside from the work in the hospital, I met some really amazing people who became friends and it’s hard and sad to walk away from it all. Also knowing I can’t be there to shoulder any of the heavy workload for them. The best I can do is pray.
 

I walk away having very mixed emotions. On one hand I’m excited to see my family and friends in Australia and somewhat relieved that my stress level is dramatically reduced by returning to a job that has equipment and drugs to keep children who are dangerously unwell alive and treated (for the most part).
One the other hand I have left behind friends with whom I now share experience of deep emotion. I have left a town of Togolese that I have shared precious moments of life with; the beginning for some and the ending for others.
I’m also afraid that when I return to work in Australia I’ll be frustrated and bored. I know there’s no fix for this and I do realise I’ve just written about how stressed I was, but there has to be a happy medium!? I don’t know what that looks like.

So, friends who are welcoming me home, be patient with me. Don’t be afraid to ask me questions, even if it feels like it could be a sensitive topic. I know I’ll feel sad and want to cry. It’s not personal. It’s not because you are not enough.

I sent a message to one of my nurse friends I left behind in Mango asking how one of the babies I looked after was going since I’d been gone. She replied saying that he passed away.  He was 8 months old. His mother had died at his birth and his grandma was caring for him. He was severely malnourished and had other things going on that we couldn’t test for or figure out treatment to cure him. I believe he’s now held by Jesus, but that doesn’t stop me from feeling sad.

I don’t know how to wrap this up and I don’t know what my next step is, but I’m on a journey like you, taking each day at a time and asking God to direct my path.

Grieving

Today I’m a bit of an emotional basket-case. I mean while watching the news I saw a report on a young family who escaped being harmed in a car accident with a truck and I actually had to choke back tears. That’s not normal for me or anyone I know.

I think it began this morning when I was filling out an application for a volunteer position with a local organisation. The lady asked me for two character referees. It couldn’t be a family member and so after I wrote down one friend’s name, I actually drew a blank with whom else to write. I had to blink back tears and explain that I’d just left my community and world for the past 5 years. Even writing that makes tears run down my face. Leaving your community, close friends, favourite job in the world and life of adventure is just plain old hard and painful.

After I did a debrief in New Zealand a few weeks ago I made myself a promise that I wouldn’t clench my teeth and hold the tears back anymore, but it comes at a cost to my pride. The other day at work I was almost reduced to tears in a conversation with the other nurses and had to just tell them I couldn’t talk about it anymore, because we were about to start handover and I could barely walk into a patient’s room all red-eyed and teary.

The thing is, I just wanted to feel welcomed home after being gone for so many years. My family welcomed me home with open arms and a few friends, but I feel at a loss for the rest of my old community. It's gone. I grew up in this town and so I know a fair population and called many friends but a few years away have changed most of their single status’, not just to married but married with children. They all have their own lives and I've had mine, so far away from anything they can connect to. So instead conversations are about the now. ‘What are you up to now?’ ‘Are you working?’ ‘How long are you staying around for this time?’ And sometimes ‘Are you settling in?’ Which really just makes me want to burst into tears. How do you settle into a different world? I want to tell them that I don’t want to forget everything I learnt but I don’t know how to fit that into this world here in Australia, but it would be lost on them.

I'm grieving. I’m grieving so many losses. In fact the loss part makes me so introverted I'd prefer to stay home and when I think about what I'm doing here now I feel tired and just plain sad. So sad that I don't want to connect with people I used to call friends because if I'm perfectly honest, if they ask how I really am I'll probably cry and if they don't ask how I am, I'll go home and cry. I'm just at a loss.

Some day I will not feel overwhelmed so easily.
Some day I will not cry every time I sing in church.
Some day I will have community again.
Some day I will not feel like a foreigner in my own town and country.
Some day I will feel as welcome in church as I do at work.
Some day I will feel like I belong again.
Some day I will not be on the verge of tears or cry so frequently.
Some day I will have a job I love.
Some day I will realise it doesn't hurt anymore to see the Africa Mercy carrying on, not needing me.

Don’t get me wrong, I am thankful for people and things here. I wouldn’t have made it this many weeks without my family and a couple of friends, but I have to keep a check on myself to make sure I’m choosing healthy ways to grieve. At least I know that God called me to be here and as painful and restless as it feels in the every day, deep down I know I'm following him.

Ripping off the Bandaid

This week when so many of my friends have flown back to their floating home, I am back in Australia and I am staying.

My departure from the ship in June wasn’t really like I thought it would be. I have been the one saying farewell one hundred times over the years and it was actually nothing like I imagined.

I have gone on holidays away from the ship so many times now, that other than having to pack up ALL of the things I have bought and accumulated in the past 5 ½ years, it felt pretty much the same. Walking down the gangway for the last time felt like every other time. Hugging my friends didn’t feel different. Sure, there was an element of sadness but I also felt fairly numb. I walked away from the group of ship family standing on the dock to the waiting car, feeling nothing. The bandaid had been coming off so slowly and painfully during the past month that it was really just time to rip it off. So I moved through the motions of goodbye, waited for the others, hopped into the car, buckled up, waved goodbye and looked behind me twice as we drove off, trying to feel something. Nothing. Blank. Apparently I'm a post-griever.

Several weeks later, it still doesn’t feel real.

I flew out of Durban, through Dubai and on to Seattle. The plane from Dubai to Seattle was pretty empty and so when the opportunity to have four seats to myself arose, I jumped up, covered myself in a blanket and promptly went to sleep laying flat, a rare luxury on a 14 hour flight.

Have any of you watched the BBC series Call the Midwife? It’s one of my favourite TV shows and comes with a 50% chance of tears. Well the airline entertainment had season 5 which I had never seen before, so being overtired and already emotional I sat in my row of four seats and watched Call the Midwife and cried. Eventually I turned the show off and just sat staring at the flight plan on the screen in front of me, thinking about all that had just happened leaving my ship home and cried. Not just silent tears either. Face screwed up and nose streaming sort of tears. No one even noticed.

Arriving in Seattle I was greeted by my friend Molly, who took beautiful care of me. After a shower and a perfect cup of coffee, we hit a Seattle highlight, Pike Place Market. I took in the colours and smells of freshly cut flowers, arts and crafts, seafoods, teas and all sorts of yummy foods. We met up with another ship friend and headed out for a sushi dinner. Around that time I hit a jetlag wall of tiredness and eventually crawled into a dreamy bed and fell fast asleep.

The next day Molly drove me out to Pier 66 where I found my friend Heather and her family, along with the Norwegian Jewel cruise ship for the next adventure. With a mixed apprehension and excitement I boarded the largest ship I’ve ever been on. So many parts of living on a ship were familiar, including the crowds that you fight everywhere to get anywhere. Of course this cruise ship was completely different to the AFM (Africa Mercy). The Norwegin Jewel is 14 decks high, it is also double the length, too many restaurants and bars to count, an art gallery, spas (hot tubs), pools and water slide, a casino and carpeted almost everywhere, just to name a few differences. There are 1,200 crew and I knew none of them, although they were all very friendly. You can eat almost all hours of the day and before you are even hungry it is time to eat again. An event is always taking place and if I hadn’t already learnt how to live with constant activity around me, and fear of missing out (FOMO) I would have been a basketcase. Instead we spent most of our hours on board staring out the windows, eating, reading, eating, playing games, eating, watching shows in the evenings and did I mention eating? Our favourite time of the night was going back to our cabin (called a stateroom on a cruise) all the way down on deck 4 forward and finding our origami towel creation on the bed.

Deck 7 walkways practically disappeared from view they were so long

 

Unfortunately mid June is too early for Salmon in Ketchikan

Ketchikan's harbour

Us at the Mendenhall Glacier, outside of Juneau

Heather checking out the glacier

The train from Skagway

Skagway harbour

One of the seven origami towel creations that we found in the evenings

We visited Ketchikan, Juneau, Skagway (all Alaska) and Victoria (B.C. Canada). We walked around each town looking in their local stores, learnt a little bit of history, watched the Lumberjack show in Ketchikan, walked to the Mendenhall glacier in Juneau, took the train up the White Pass and Yukon Route in Skagway and walked the streets of Victoria. It was fun and so beautiful. We saw dolphins and whales, glaciers and icebergs, waterfalls and snow-capped mountains. All the while my mind had intermittently been churning thoughts of returning to Australia and all that comes with it, but to keep my head in the game I tried to concentrate on where I was presently and focus on that.

From Seattle we travelled down to my friend’s town Medford, Oregon. Then the following day after a beautiful morning outdoor church service, different friends (Tim and Karin) picked me up and we drove back up to Portland. There we tasted some of Portland’s delicious foods, Pip’s Original Doughnuts and Chai, Salt and Straw for gourmet ice-cream, schwarmas from a street food truck to name a few. We hiked trails and drove the Fruit Loop tasting wines and ciders while catching up and talking of old times.

Chai and doughnuts at Pip's

Cider tasting at the Hood River Fruit Loop

Onward from Portland I flew to Durango, Colorado where I joined Mercy Ships friends from all over the US, Canada and even my kiwi friend who’s living in Northern Togo. We squeezed into every bed in our generous host’s house, some overflowing into tents, others in pop-up camper vans. Every day held adventures, hiking trails in the mountains (we got hailed on and froze when the temperature dropped significantly and it rained the whole walk down), soaked in the hot springs in Ouray, went white water rafting down the local river with Durango friends, a day out on a shooting range, lots of BBQs and meals together, Dutch Blitz, bocce ball and cornhole games. It was so fun to see so many friends that I hadn’t seen in years. I love it when you can just pick up exactly where you left off.

 

Ouray Hot Springs

Look at the size of this thing!

Hitting the 200yd, 300yd and 400yd targets took just 4 bullets!

The mark where my bullet hit and then ricocheted off and hit Mirm in the forehead

Soothing baby Bennett took some African mama style

The American cornhole game

 

After Colorado I flew to Virgina to see Stacia and her family. I always think it’s interesting to see where your friends grew up and all the things that are normal for them in contrast to your own ‘normal’ upbringing. From Virginia we drove through Charlotte, North Carolina for a quick stop and onward to Nashville, Tennessee where we got to join our friends Josh and Katie for their wedding! Another beautiful ship love story became until-death-do-us-part in a gorgeous outdoor ceremony in the woods of Tennessee.

 

The plan was to explore Nashville the next day and after driving around the music recording studios, walking the streets and eating lunch in a pub with great live country music, I had expired and was reduced to tears in the airport car park after dropping Heather off. I was exhausted and wanted nothing more than to lie down and close my eyes, but with nowhere to go and an 8+ hour drive the following day, we said goodbye to other friends in the city and knocked 2 hours off our drive for the next day, enjoying the golden hour of sunshine hitting the trees as we drove and ending up in a random town, hotel and the 12th bed I'd slept in that trip.

Do you feel tired just reading this? Yeah me too. Let’s take a break.

I Don’t Want to Forget

It's the time of year I really dislike the most. The hospital has closed and so I am no longer a nurse which means I not only have a different job but I no longer have daily contact with the Malagasy people which leaves me feeling disconnected. I've also said goodbye to no less than 50 friends, many of whom I'll probably never see again unless we put in major effort. Now that the hospital is packed up and I'm sitting at a computer every day, I'm just itching to get out of here and start the next part of the journey. It's not that I want to leave Madagascar it's that my reason for being here, my normal day to day life, has been removed and the crew has shrunk from about 450 to 200. It's so evident by the empty dock and deck 8 loaded full of vehicles, that we're almost ready to hit the open ocean.

I am ready because I feel a little like I have nothing left to give this country or many of those around me. The end of field service sucks you dry of emotion with so many goodbyes. I am dried up like a raisin. I look around the ship which is my home and try to imprint each special thing about it into my memory, the cafe in which I have eaten two meals a day for years, the dining room hustle and bustle which is now quiet and calm, my little cabin space which is now the most empty it has ever been, the short commute to any place I go, two minutes being the longest time it takes to get anywhere on board. Then most importantly I am consciously committing to memory the people that are my family in this place.

You might wonder why I've chosen to stay throughout this period and not just taken flight. Although it's been tough and it's not over yet, I find it is part of the process of letting go and closure to the chapter. As each goodbye is said, a page turns to mark the end of that season, whether it be goodbye to patients, day crew, friends or the closure of the hospital. When I look around I see that those chapters have ended- the hospital is empty, a shell of its former busy self. My friends aren't there anymore, I think I see them or hear their voice but it's a mistake when I turn my head to find them.
Setting sail is the second last chapter in this season. It is a physical departure from Mada that gives time for reflection before jumping onto the next adventure.

After a very rainy month our last weekend in Mada is beautifully sunny, with the odd shower and despite the fact that I'm tied to the ship with a duty nurse pager today I have been able to soak in the rays from the dock, enjoying the warm breeze, the puffy clouds floating in the blue, blue sky, the mooring lines slacking and tightening above the rippling sea. Beneath where my feet hang, tropical fish swim along the dock wall and there's a big fat starfish under the sea visible from the gangway.

Last weekend as I was sitting in a vehicle traveling for hours I watched with a keen eye everything passing me on the streets and decided to make a list of things I might have forgotten to tell you about.

Have I ever told you...

How much the Malagasy people like hats? Everywhere you look on the streets, adults and children alike are wearing hats.

How hard the Malagasy people work planting, harvesting, drying, and readying their rice to eat?

How resourceful they are using travellers palms for plates, spoons, wrapping, drying out for weaving baskets, placemats, bags, anything woven? They build their houses from the dried branches laid on top of each other and woven together.

How many pot holes their roads have? One man we met told us that in French pot holes are called chicken nests. I was told the roads only get worked on close to election time, so most roads go for a long time between being fixed.

How much I love seeing the community movement on the streets? They are selling goods, braiding hair, drying rice, pumping water, washing clothes, weaving, pushing carts, herding zebu, standing on the side of the road selling chickens hung by their bound feet or freshly caught fish.

How the peoples’ faces break into smiles when we speak Malagasy to them? Salama, ina vaovao? Tsy misy vaovao.

 
How clever they are at riding bikes with a second person perched on the front bar, sometimes as small as a toddler?

How beautiful the stretching green landscape and rivers are?

How colourful the woven crafts are?

How the main mode of public transport for long distance is a taxi-bruisse which is a van with four rows of seats? It seats as many people as you can fit across the seat, about 22 altogether. The other modes of transport is pousse-pousse (bicycle pedaled) and tuk tuk (motored).

How my favourite Malagasy lunch or dinner is brochette de zebu or brochette de poulet avec pomme frite or legumes? The best breakfast around is Portuguese omelette, jus grenadelle, cafe au lait and pan au chocolat.

How chickens roam everywhere? It seems no matter where you are, there will be a chicken there scratching around for food. They have long skinny legs and remind me of a T-Rex dinosaur.

How much I love to drink fresh coconut milk from the coconut selling men and women along the beach road? After you finish the milk if you hand it back to them they will cut it open and dig out the flesh for you. It is so delicious. Some stalls even have a fridge to make the coconut milk cold.

Have I ever told you how much I have enjoyed living in this country? Its people are some of the most beautiful I have ever met. It is a land I truly hope I am able to return to in the future, for it holds a large piece of my heart.